Examination of head, especially newborn, infant
· General observation of the contour of the head is important since molding occurs in almost all vaginal deliveries
· The usual, more oval contour of the head is apparent by 1 to 2 days after birth
· Changes occur b/c the bone of the cranium are not fused, allowing for overlapping of the edges of these bones to accommodate the size of the birth canal during delivery
Basic information on cranium:
· Six bones- the frontal, occipital, two parietals, and 2 temporals make up the cranium
· Btwn the junction of these bones are bands of c.tissue called sutures
· At the junction of the sutures are wide space of unossified membranous tissues called fontanels
· The 2most prominent fontanels in the infant are the anterior frontanel and posterior frontanel
Assessment:
· The skull is palpable for all patent sutures and frontanels noting size, shape, molding, and abnormal closure
· Sutures feel like cracks btwn the skull bones
· Fontanels feel like wider soft spots
· Palpable by using the tip of the index finger and running it along the ends of the bones
· Anterior fontanel is a diamond shape and measures anywhere from barely palpable to 4 to 5 cm (about 2 inches)
· Posterior fontanel is triangular, usually measuring btwn 0.5 and 1 cm (less than ½ an inch)
Fontanels
· Should feel flat, firm, and well demarcated against bony edges of the skull
· Frequent pulsations are visible at the anterior fontanel
Also:
· Palpate the skull for any unusual masses or prominences, particularly those resulting from birth trauma, such as caput succedaneum or cephalhemotoma
· Assess also the degree of head control- Degree of ability to control head in certain positions is significant
· Head lag is normal in newborns the degree of ability to control the head in certain positions should be recognized
· What to look for when testing for head lag: if the supine infant is pulled from the arms into a semi-Fowler position, marked head lag and hypertension are noted
· The newborn can momentarily hold head midline when lifted vertically
· If head lag present at 6 monthsà refer to physician
· General observation of the contour of the head is important since molding occurs in almost all vaginal deliveries
· The usual, more oval contour of the head is apparent by 1 to 2 days after birth
· Changes occur b/c the bone of the cranium are not fused, allowing for overlapping of the edges of these bones to accommodate the size of the birth canal during delivery
Basic information on cranium:
· Six bones- the frontal, occipital, two parietals, and 2 temporals make up the cranium
· Btwn the junction of these bones are bands of c.tissue called sutures
· At the junction of the sutures are wide space of unossified membranous tissues called fontanels
· The 2most prominent fontanels in the infant are the anterior frontanel and posterior frontanel
Assessment:
· The skull is palpable for all patent sutures and frontanels noting size, shape, molding, and abnormal closure
· Sutures feel like cracks btwn the skull bones
· Fontanels feel like wider soft spots
· Palpable by using the tip of the index finger and running it along the ends of the bones
· Anterior fontanel is a diamond shape and measures anywhere from barely palpable to 4 to 5 cm (about 2 inches)
· Posterior fontanel is triangular, usually measuring btwn 0.5 and 1 cm (less than ½ an inch)
Fontanels
· Should feel flat, firm, and well demarcated against bony edges of the skull
· Frequent pulsations are visible at the anterior fontanel
Also:· Palpate the skull for any unusual masses or prominences, particularly those resulting from birth trauma, such as caput succedaneum or cephalhemotoma
· Assess also the degree of head control- Degree of ability to control head in certain positions is significant
· Head lag is normal in newborns the degree of ability to control the head in certain positions should be recognized
· What to look for when testing for head lag: if the supine infant is pulled from the arms into a semi-Fowler position, marked head lag and hypertension are noted
· The newborn can momentarily hold head midline when lifted vertically
· If head lag present at 6 monthsà refer to physician